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Walnuthead appears beside his leader as well as fellow troops Sharpteeth and Needles when a man named Vincent, who was transported to Carrboro Louisiana where he discovers the Carrboro Configuration inside Carrboro Hansen's Disease Center and he solves the box. Needles was a witness to a deal Hunger made with Vincent stating that if he brought Hunger souls that Hunger would make him a cenobite later, and Vincent agreeing.

Even though Vincent had been loyal to his deal with Hunger, when he gos looking for the Carrboro Lament configuration in the Disease Center he unknowingly solves it as the Disease center was a puzzle box too and Walnuthead beside Hunger and the other Troops come and drag Vincent to Hell.

A man named Byron, during one family reunion, burns down a house with the entire family in it, killing them. Then Byron solves the Book of Riddles and summons Hunger, with Walnuthead, and the troops Sharpteeth and Needles, alongwith three troops new to Hunger's Gash, Burns, Nosferatu, Gridhead as well as a single cenobite pet. Hunger makes two cenobite pets from the family's remains and then takes Byron and Whitcomb, Byron's cousin, to Hell.

Walnuthead truley is one of a kind in the world of the cenobites, his head had been mutilated so greatly that it almost looks like he is a walnut eating its own neck, hence his name, Walnuthead also has wide set eyes and wears a classic form of the leather bound cenobite uniform with a high collar.